July Prime Timers' Shabbat Dinner
Friday, July 19, 2024 | Following services

Join us immediately following Shabbat services at the home of Andrea and John Nadai for a Chinese food Shabbat dinner!

REGISTRATION

Are you a TBE Member?

YesNo

Number of adult guests attending:

Number of adult member guests attending:

Number of adult non member guests attending:

First Name

Last Name

Mobile Phone

Primary Email

First Name

Last Name

Mobile Phone

Primary Email

CUSTOM QUESTIONS

Are you age 65 or older?

Yes

How will you be attending?

In PersonOnline

Will you be taking the bus?

Yes

I would be interested in carpooling with TBE

Yes

TOT SHABBAT DATES

We would like to register for the following dinners: You can always come back to this form and register for additional dinners in the future!

Month X1, 202X: 5:30pmMonth X2, 202X: 5:30pmMonth X3, 202X: 5:30pmMonth X4, 202X: 5:30pmMonth X5, 202X: 5:30pmMonth X6, 202X: 5:30pmMonth X7, 202X: 5:30pmMonth X8, 202X: 5:30pm

NUMBER OF CHILDREN ATTENDING

Number of youth members attending:

Number of youth non-members attending:

First Name (Child #1)

Last Name (Child #1)

Grade (Child #1)

Age (Child #1)

First Name (Child #2)

Last Name (Child #2)

Grade (Child #2)

Age (Child #2)

First Name (Child #3)

Last Name (Child #3)

Grade (Child #3)

Age (Child #3)

First Name (Child #4)

Last Name (Child #4)

Grade (Child #4)

Age (Child #4)

First Name (Child #5)

Last Name (Child #5)

Grade (Child #5)

Age (Child #5)

First Name (Child #6)

Last Name (Child #6)

Grade (Child #6)

Age (Child #6)

First Name (Child #7)

Last Name (Child #7)

Grade (Child #7)

Age (Child #7)

First Name (Child #8)

Last Name (Child #8)

Grade (Child #8)

Age (Child #8)

First Name (Child #9)

Last Name (Child #9)

Grade (Child #9)

Age (Child #9)

SESSION CHOICES

Members

FallWinter Spring ISpring II

Non Members

FallWinter Spring ISpring II

PHOTO & VIDEO PERMISSIONS

I grant my permission to use any and all written comments, pictures, or video in which my child or I may appear for print, audio, visual, and/or electronic publicity promotion and advertising on behalf of TBE and its programs.

YesNo

DIETARY RESTRICTIONS & FOOD ALLERGIES

Please list any dietary restrictions and/or food allergies:

GENERAL & MEDICATION ALLERGIES

Please list any general allergies and/or allergies to medications:

MEDICAL CONDITIONS

Please list any medical conditions:

EMERGENCY CONTACT INFORMATION

Emergency Contact #1

Full Name

Mobile Phone

Primary Email

Relationship

Emergency Contact #2

Full Name

Mobile Phone

Primary Email

Relationship

BILLING INFORMATION

First Name

Last Name

Primary Email

Mobile Phone

Billing Street

Billing Unit/Apt.

Billing City

Billing State

Billing Zip Code

Is your mailing address the same as your billing address?

YesNo

Mailing Street

Mailing Unit/Apt.

Mailing City

Mailing State

Mailing Zip Code

Credit Card No.

Exp. Month

MM

Exp. Year

YYYY

Verification Code

Total

$

HIDDEN FIELDS

Form Requests Hidden Fields

FORM #1: ARE YOU A TBE MEMBER?

Yes

FORM #2: # OF ADULT GUESTS ATTENDING?

Yes

FORM #3: # OF ADULT MEMBER GUESTS ATTENDING?

Yes

FORM #5: # OF ADULT NON-MEMBER GUESTS ATTENDING?

Yes

FORM #6: ARE YOU 65 OR OVER?

Yes

FORM #7: HOW WILL YOU BE ATTENDING?

Yes

FORM #8: WILL YOU BE TAKING THE BUS?

Yes

FORM #9: I WOULD BE INTERESTED IN CARPOOLING

Yes

FORM #10: TOT SHABBAT DINNERS

Yes

FORM #11: NUMBER OF CHILDREN ATTENDING?

Yes

FORM #12: # OF YOUTH MEMBERS ATTENDING?

Yes

FORM #13: # OF YOUTH NON-MEMBERS ATTENDING?

Yes

FORM #14: SESSION SEASONAL BOXES FOR MEMBERS & NON-MEMBERS?

Yes

FORM #15: PHOTO & VIDEO PERMISSIONS?

Yes

FORM #16: DIETARY RESTRICTIONS & FOOD ALLERGIES

Yes

FORM #17: MEDICAL CONDITIONS

Yes

FORM #18: GENERAL/MEDICATION ALLERGIES

Yes

FORM #19: SUGGESTED DONATION

Yes

FORM #20: EMERGENCY CONTACT (NAME, PHONE NUMBER, EMAIL, RELATIONSHIP

Yes

General Hidden Fields

Authnet_Hidden_Fields

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